MEDICARE: RAQUEL-MONET TUCKER RBT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician	1-07-3468	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1-07-3468	OTHER		RBT CERTIFICATION - RELIAS LEARNING

General Provider Information

NPI Number	:	1083224299
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAQUEL-MONET TUCKER RBT

Provider Business Mailing Address
First Line	:	5710 OGEECHEE ROAD
Second Line	:	SUITE 200 - 251
City	:	SAVANNAH
State	:	GA
Zip	:	31405-9515
Country	:	US
Telephone Number	:	912-434-4343
Fax Number	:	912-452-9600

Provider Business Practice Location Address
First Line	:	5710 OGEECHEE ROAD
Second Line	:	SUITE 200 - 251
City	:	SAVANNAH
State	:	GA
Zip	:	31405-9515
Country	:	US
Telephone Number	:	912-434-4343
Fax Number	:	912-452-9600

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/03/2020
Last Update Date	:	11/27/2023

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Directions to “ RAQUEL-MONET TUCKER RBT” Practice Location

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